| National Provider Identifier [NPI]: | 1043357262 |
| Last Name Of The Provider | BALLARD |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 818 MAGNOLIA AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CORONA |
| Zip Code Of The Provider | 928793106 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 370 |
| Number Of Medicare Beneficiaries | 138 |
| Total Submitted Charge Amount | 42061.5 |
| Total Medicare Allowed Amount | 25708.93 |
| Total Medicare Payment Amount | 17178.86 |
| Total Medicare Standardized Payment Amount | 16530.84 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 63 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 1188.5 |
| Total Drug Medicare AllowedAmount | 506.23 |
| Total Drug Medicare PaymentAmount | 466.84 |
| Total Drug Medicare Standardized Payment Amount | 466.84 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 25 |
| Number Of Medical Services | 307 |
| Number Of Medicare Beneficiaries With Medical Services | 138 |
| Total Medical Submitted Charge Amount | 40873 |
| Total Medical Medicare Allowed Amount | 25202.7 |
| Total Medical Medicare Payment Amount | 16712.02 |
| Total Medical Medicare Standardized Payment Amount | 16064 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 53 |
| Number Of Beneficiaries Age 75 to 84 | 30 |
| Number Of Beneficiaries Age Greater 84 | 21 |
| Number Of Female Beneficiaries | 81 |
| Number Of Male Beneficiaries | 57 |
| Number Of Non Hispanic White Beneficiaries | 65 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 18 |
| Number Of Hispanic Beneficiaries | 38 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 89 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 49 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2516 |